Would Australians support mandates for the COVID-19 vaccine? Our research suggests most would


Dean Lewins/AAP

David Smith, University of Sydney; Katie Attwell, The University of Western Australia, and Uwana Evers, The University of Western AustraliaAustralia’s vaccine rollout is moving far more slowly than the government had hoped, and there is evidence of vaccine hesitancy in a significant part of the population.

Some governments and media outlets are already considering whether mandates will be needed to reach sufficient vaccine coverage.

Last year, Prime Minister Scott Morrison briefly suggested a vaccine would be mandatory before walking it back hours later.

Supply and rollout problems must clearly be solved first. But if mandates do come back on the table in the face of vaccine hesitancy, our research sheds light on how widely supported they would be.

Last year, with our research partner Pureprofile, we surveyed 1,200 Australians about whether they would take a COVID-19 vaccine when it became available. We also asked if they thought the government should make the vaccine a requirement for work, travel and study.

Our sample included 898 respondents we had previously surveyed in 2017. Back then, we asked their opinions about the safety and necessity of vaccines and whether they supported the federal government’s “No Jab, No Pay” policy, which takes away financial entitlements from vaccine refusers.




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Of those who participated in both the 2017 and 2020 surveys, 88% agreed in 2017 with the statement that “vaccines are safe, necessary and effective”. Yet 30% gave a hesitant response (“maybe” or “no”) when asked in 2020 if they would take the coronavirus vaccine.

We asked all hesitant respondents why they were hesitant. Just 8% of them were “against vaccines”. Another 16% indicated they weren’t personally concerned about the coronavirus. But an overwhelming 70% had safety concerns about the vaccine because of how quickly it was being developed.

New research has found widespread support among Australians for mandating COVID-19 vaccination.
David Caird/AAP

This level of vaccine hesitancy is very high by Australian standards, but it is unfortunately normal for COVID-19. Other local and international studies have also found much higher than normal hesitancy about COVID-19 vaccines, driven by a variety of factors. Despite this higher-than-usual hesitancy, a comfortable majority of Australians still want the vaccine.

Moreover, large majorities of Australians are in favour of government mandates for COVID-19 vaccines. Surprisingly, more respondents in our survey said they favoured the government making the vaccine a requirement (73%) than said they would definitely take it themselves (66%).

This is the opposite of what vaccination mandate studies usually find in the US, where there is less support for government mandates than there is for personally taking vaccines. However, it is in line with what other researchers have found about Australians during the pandemic. We have generally been highly accepting of strict government measures to control it, even if we don’t agree with them. This may also be evidence of a broader culture of rule-following.

Another crucial difference between Australians and Americans is in the political makeup of support for COVID-19 vaccines. While vaccine hesitancy in the US previously didn’t map onto party-political affiliation, it has very much done so for COVID-19.

Donald Trump’s opposition to other measures to fight the pandemic, his scepticism about the pandemic itself, and perhaps even his earlier statements about childhood vaccines seem to have caused widespread rejection of the COVID-19 vaccine among Republicans. This is in spite of the Trump administration’s significant support of vaccine development, and Trump’s own claim that he is the “father of the vaccine”.

Making vaccinations mandatory is even less popular with Republicans, and threatens to become a significant culture war issue.




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However, in Australia, the COVID-19 vaccine and the prospect of government requirements are popular. Supporters of both the Coalition parties and Labor, which between them form every state and federal government in the country, embrace both: 72% of these major party voters say they would definitely take the vaccine, while 79% of them support requirements for it. There is no statistically significant difference between supporters of the different parties.

Donald Trump has recently declared himself the ‘father’ of the vaccine, despite being publicly sceptical at first about the seriousness of the virus.
Gerald Herbert/AP/AAP

On the other hand, voters whose first preference would go to another party or independent were more hesitant about the vaccine and requiring it. Only 56% of them said they would definitely take the vaccine, while 61% said they would support a mandate.

Politicians from the Coalition and Labor have led Australia’s response to COVID-19, appearing alongside each other in a sometimes fractious but generally co-operative national cabinet. So perhaps it isn’t surprising that supporters of these parties also support vaccination in large numbers.

The biggest pockets of opposition are found in supporters of parties that usually don’t form government, and which challenge the major party consensus from both the left and right. It is important to emphasise that even a majority of these minor party voters would definitely take the vaccine, and would also support government requirements to do so. But we must keep in mind that vaccine hesitancy may well have an “anti-establishment” character in Australia, found among those who are less satisfied with the major parties.

We conducted our survey before any vaccine had been developed, let alone rolled out. Now that Australians have seen both the spectacular successes and rare but worrying adverse events following some brands of vaccination, should we expect them to have different views?

The market research company Ipsos undertook the only other national study we know of on attitudes to making COVID-19 vaccinations mandatory. In January, Ipsos asked whether this should be the case for those over 18, and found 54% of Australians said yes, 35% said no and 10% were unsure.

The stronger language of “mandates” and less clarity about what mandatory means in practice may have prompted less support than in our study. Comparisons to 13 other countries put Australians somewhere in the middle in terms of acceptance of mandates. The Ipsos survey, like ours, was conducted prior to the recent pivot away from AstraZeneca vaccination for under 50s.

However, a recent survey of Western Australians found much higher support when respondents were asked about a specific requirement. Some 86% of respondents said they would favour making a vaccine mandatory for anyone who wanted to travel overseas.

The authors of this piece are neither anti- nor pro- vaccine mandates. We believe in certain circumstances it is appropriate for governments to require people to be vaccinated, and we prefer this to leaving vaccine mandates to the private sector. The development of any mandatory vaccination policies should involve robust and transparent engagement with the public.

However, we believe mandates should be a policy of last resort. Well-funded and targeted public communications, easy access and incentives should come first. We are still waiting for our own eligibility to be vaccinated, so there is a long way to go.The Conversation

David Smith, Associate Professor in American Politics and Foreign Policy, US Studies Centre, University of Sydney; Katie Attwell, Senior Lecturer, The University of Western Australia, and Uwana Evers, Adjunct Research Fellow, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The pressure is on for Australia to accept the coronavirus really can spread in the air we breathe


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C Raina MacIntyre, UNSWMore than a year into the pandemic, the World Health Organization (WHO) and US Centers for Disease Control finally changed their guidance to acknowledge SARS-CoV-2, the virus that causes COVID-19, can be transmitted through the air we breathe.

In Australia, we’ve just had the latest leak from hotel quarantine, this time in South Australia. Investigations are under way to find out whether a man may have caught the virus from someone in the hotel room next to his, before travelling to Victoria, and whether airborne transmission played a role.

These examples are further fuelling calls for Australia to officially recognise the role of airborne transmission of SARS-CoV-2. Such recognition would have widespread implications for how health-care workers are protected, how hotel quarantine is managed, not to mention public health advice more broadly.

Indeed, we’re waiting to hear whether official Australian guidelines will acknowledge the latest evidence on airborne transmission, and amend its advice about how best to protect front-line workers.

The evidence has changed and so must our advice

At the beginning of the pandemic, in the absence of any scientific studies, the WHO said the virus was spread by “large droplets” and promoted handwashing. Authorities around the world even discouraged us from wearing masks.

A false narrative dominated public discussion for over a year. This resulted in hygiene theatre — scrubbing of hands and surfaces for little gain — while the pandemic wreaked mass destruction on the world.

But handwashing did not mitigate the most catastrophic pandemic of our lifetime. And the airborne deniers have continually shifted the goalposts of the burden of proof of airborne spread as the evidence has accrued.




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What does the evidence say?

SARS-CoV-2 is a respiratory virus that multiplies in the respiratory tract. So it is spread by the respiratory route — via breathing, speaking, singing, coughing or sneezing.

Two other coronaviruses — the ones that cause MERS (Middle Eastern respiratory sydrome) and SARS (severe acute respiratory syndrome) — are also spread this way. Both are accepted as being airborne.

In fact, experimental studies show SARS-CoV-2 is as airborne as these other coronaviruses, if not more so, and can be found in the air 16 hours after being aerosolised.

Several hospital studies have also found viable virus in the air on a COVID-19 ward.

Established criteria for whether a pathogen is airborne scores SARS-CoV-2 highly for airborne spread, in the same range as tuberculosis, which is universally accepted as airborne.

A group of experts has also recently outlined the top ten reasons why SARS-CoV-2 is airborne.

So why has airborne denialism persisted for so long?

The role of airborne transmission has been denied for so long partly because expert groups that advise government have not included engineers, aerosol scientists, occupational hygienists and multidisciplinary environmental health experts.

Partly it is because the role of airborne transmission for other respiratory viruses has been denied for decades, accompanied by a long history of denial of adequate respiratory protection for health workers. For example, during the SARS outbreak in Canada in 2003, denial of protection against airborne spread for health workers in Toronto resulted in a fatal outbreak.

Even influenza is airborne, but this has been denied by infection control committees.




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What’s the difference between aerosols and droplets?

The distinction between aerosols and droplets is largely artificial and driven by infection control dogma, not science.

This dogma says large droplets (defined by WHO as larger than 5 micrometres across) settle to the ground and are emitted within 2 metres of an infected person. Meanwhile, fine particles under 5 micrometres across can become airborne and exist further away.

There is in fact no scientific basis for this belief. Most studies that looked at how far large droplets travelled found the horizontal distance is greater than 2 metres. And the size threshold that dictates whether droplets fall or float is actually 100 micrometres, not 5 micrometres. In other words, larger droplets travel further than what we’ve been led to believe.

Leading aerosol scientists explain the historical basis of these false beliefs, which go back nearly a century.

And in further evidence the droplet theory is false, we showed that even for infections believed to be spread by droplets, a N95 respirator protects better than a surgical mask. In fact airborne precautions are needed for most respiratory infections.

Why does this difference matter?

Accepting how SARS-CoV-2 spreads means we can better prevent transmission and protect people, using the right types of masks and better ventilation.

Breathing and speaking generate aerosols. So an infected person in a closed indoor space without good ventilation will generate an accumulation of aerosols over time, just like cigarette smoke accumulates.

A church outbreak in Australia saw spread indoors up to 15 metres from the sick person, without any close contact.

Masks work, both by preventing sick people from emitting infected aerosols, and by preventing well people from getting infected. A study in Hong Kong found most transmission occurred when masks weren’t worn inside, such as at home and in restaurants.




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Coughing generates more aerosols

The old dogma of droplet infection includes a belief that only “aerosol generating procedures” — such as inserting a tube into someone’s throat and windpipe to help them breathe — pose a risk of airborne transmission. But research shows a coughing patient generates more aerosols than one of these procedures.

Yet we do not provide health workers treating coughing COVID-19 patients with N95 respirators under current guidelines.

At the Royal Melbourne Hospital, where many health worker infections occurred in 2020, understanding airflow in the COVID ward helped explain how health workers got infected.

Think about it. Airborne deniers tell us infection occurs after a ballistic strike by a single large droplet hitting the eye, nose or mouth. The statistical probability of this is much lower than simply breathing in accumulated, contaminated air.

The ballistic strike theory has driven an industry in plastic barriers and face shields, which offer no protection against airborne spread. In Switzerland, only hospitality workers using just a face shield got infected and those wearing masks were protected.




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In hotel quarantine, denial of airborne transmission stops us from fixing repeated breaches, which are likely due to airborne transmission.

We need to select quarantine venues based on adequacy of ventilation, test ventilation and mitigate areas of poor ventilation. Opening a window, drawing in fresh air or using air purifiers dramatically reduce virus in the air.




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We need to provide N95 respirators to health, aged-care and quarantine workers who are at risk of high-dose exposure, and not place them in poorly ventilated areas.

It’s time to accept the evidence and tighten protection accordingly, to keep Australia safe from SARS-CoV-2 and more dangerous variants of concern, some of which are vaccine resistant.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Grattan on Friday: Is that the Coalition debt truck parked just past the election?


Michelle Grattan, University of CanberraIt was a small thing but a revealing moment during Scott Morrison’s Wednesday interview on Nine’s Today show.

Presenter Karl Stefanovic noticed Morrison seemed out of sorts, despite the government having delivered the night before a benign budget that was well received and likely to be popular.

“It is a very big budget. Josh Frydenberg had a very big smile on his face this morning. I thought you might be happier this morning, PM. Everything OK?” Stefanovic asked.

Morrison said he was “fine”. He went on: “I’ve got to tell you, Karl, the reason is this.

“I know, look, budgets are big events and that’s all fine, but I just know the fight we’re in – and the fight we’re in, and me as prime minister I’m in, is to be protecting Australians at this incredibly difficult time.

“I am very cognisant of how big those challenges are. It is with me every second of every day.”

There are a few points to be made here.




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First, the government is using the budget to talk up the current threat of the pandemic to an extent it hadn’t been recently.

Morrison, in particular, had previously been anxious to emphasise the return to as much normality as possible. Now it’s more about lurking dangers.

These provide a justification for the government’s mega spending in the budget. (“Did anyone miss out? Perhaps only the beekeepers of Australia,” quipped one cynical Liberal backbencher.)

The language also indicates Morrison wants to do what state and territory leaders have done – use the pandemic to pave the path to electoral victory.

The other point highlighted by the Today exchange is that Morrison was looking somewhat ragged.

This was accentuated by the contrast with Treasurer Josh Frydenberg who, on the face of it, would have been under the greater stress.

Frydenberg’s performances in the week of his third budget were smooth and, whatever nerves he felt, he appeared unfazed.

The week reinforced the impression he is in the box seat eventually to reach the prime ministership (assuming the Coalition lasts in government).

Pre-budget, he and wife Amie were out for the cameras on a Sunday charity run in Canberra. Post-budget, his staff rang around backbenchers to ask if they’d like a picture with the treasurer.

In question time, Morrison found old problems returning to irritate him. He was pressed on the two internal inquiries into who in his office knew or did what in relation to the Brittany Higgins matter, and he had to say neither was concluded (one had been on hold before this week while the police dealt with their investigation of her rape allegation). Whatever the results of these inquiries, Morrison needs to get them cleared away as soon as possible. They are “barnacles”.

Morrison has been travelling a lot recently and may be tired (although those around him say he’s energised by being on the road). Or he may not be used to sharing the limelight. Or the endless round of everything may be just taking its toll.

Then there’s the challenge of explaining this Labor-lite budget to the hardliners in the Liberal base and among the right-wing commentariat.

The budget has made the opposition’s already formidable task of carving out room for itself more difficult, but it is also proving a hard swallow for those rusted on to the Coalition’s old “debt and deficit” preoccupation.




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Many of these critics will be reluctant to buy the proposition the big spending must continue because the pandemic is a constant threat, given they’ve thought the threat was exaggerated in the first place.

The government could attempt to deal with these critics by saying it will “snap back” into tackling debt and deficit as quickly as possible.

But facing an election soon, it doesn’t want to do this, for obvious reasons.

In the budget the timing of the next stage, fiscal consolidation, is imprecise.

The budget papers say: “Progress on the economic recovery will be reviewed at each Budget update. This phase of the Strategy will remain in place until the economic recovery is secure and the unemployment rate is back to pre-crisis levels or lower.”

While some commentary is focused on how the Coalition has done a dramatic U-turn from its old debt-and-deficit rhetoric, there’s an opportunity for Labor to run a major scare campaign claiming it’s not a U-turn at all – that the debt truck is just in the parking lot.

Remember, it can say, when Tony Abbott promised no cuts to health, education and even the ABC – and recall what happened. This time, so the argument runs, cuts and savings will be Coalition priorities again as soon as it has secured the votes.

Morrison and Frydenberg this week have been invoking John Howard’s advice, given to Frydenberg in the early days of the pandemic, that “in times of crisis there are no ideological constraints”.

The question is whether the Liberals have softened their ideology, or just put it in storage during the crisis.

While there can be no definite answer, Tim Colebatch, writing in Inside Story. makes a strong case that the Coalition “won’t dump its political tactic of branding itself as the ‘fiscally responsible’ party and Labor as the party standing for deficits. This [budget] is a short-term tack that will be reversed after the election.

“Of course no government promising $503 billion of deficits in five years can be called fiscally responsible, so it will make cuts then to reclaim the brand,” Colebatch says.

Morrison and Frydenberg are both pragmatists rather than ideologues. But opinions in the wider party are also relevant, as Malcolm Turnbull found on the climate issue.

Frydenberg has pledged there will not be “any sharp pivots towards ‘austerity’”.

Nevertheless, there must be a budgetary reset at some point. And whether a pivot is sharp or not, and what amounts to “austerity” depend in part on whether you are one of the losers.




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The Conversation


Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Albanese’s $10bn pledge pushes housing needs back into the limelight


Hal Pawson, UNSWOpposition Leader Anthony Albanese’s budget reply speech last night highlighted Australia’s huge unnmet need for social and affordable housing. It’s once again shaping up as a major election issue. Labor is proposing a A$10 billion program to build 30,000 social and affordable homes over five years.

The immediate backdrop for the pledge is a post-COVID house price boom, and a continuing dearth of Commonwealth investment in new non-market housing. That is, rentals affordable to low-income Australians and provided by government agencies or non-profit community housing organisations.

Amid the many new spending plans revealed in Tuesday’s budget, Treasurer Josh Frydenberg maintained the government’s resistance to an ever-wider coalition of voices calling for social housing stimulus.




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Conversation Economic Society of Australia survey, September 2020

Just how big is the problem?

With borders largely closed since March last year, it’s true that sharply reduced migration has temporarily dampened rental housing demand over the past 15 months. That in turn has generally subdued increases in rents. However, that national norm masks the rapidly rising rents seen in many regional markets during 2020-21.

And despite some local price reductions, Anglicare’s recent survey of 74,000 “lease ready” property listings identified only three (0.004%) affordable to a single person on the JobSeeker payment. More strikingly, for every household income type included in the survey, Anglicare found the availability of affordable lets even lower in early 2021 than a year earlier.

The broader and longer-term picture in the private rental market has been one of shrinking numbers of tenancies that low-income Australians can afford to rent. Specifically, we saw a 50% increase in the national deficit in private lets affordable to low-income renters (in the bottom 20% of incomes) in the decade to 2016.

A decade of negligible investment in social housing construction has only made this situation worse. The result has been a continued decline in availability as public and community housing has dwindled from 6% to only 4% of all housing since the 1990s. In fact, proportionate to population, social rental lettings have halved over this period.

A clear point of difference, but not a game-changer

Tuesday’s budget marked a continuation of the Morrison government’s near-exclusive housing focus on efforts to assist aspirational first-home buyers. Most significantly, this policy stance inspired the $2.1 billion HomeBuilder program as an economic recovery measure during 2020-21.




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The ALP has pointedly backed both HomeBuilder and the smaller measures to assist first-home buyers announced on Tuesday. But Albanese’s new announcement seemingly extends Labor’s housing pitch beyond the Coalition’s comfort zone.

Anthony Albanese pledges $10 billion to build social housing in budget reply speech.

So is this the “major initiative” hailed by some headline writers? A “fix for house prices” it certainly is not. If unwisely attempted purely through public spending, the funding required to get into that territory would need to be many times as great.

Opposition housing spokesperson Jason Clare more defensibly describes the ALP pitch as “a significant start” in tackling Australia’s “housing crisis”.

The current national stock of social and affordable rental housing totals just over 400,000. In recent years annual additions have amounted to only 2,000-3,000. That’s barely enough even to offset continuing sales and demolitions. In these terms, Albanese’s pledge to expand the supply by 6,000 a year would indeed be significant.

At the same time, as our previous research has shown, a net increase of 15,000 units a year is needed just to keep pace with “normal” population growth – that is, to halt the decline in social rental as a share of all housing. Even under a post-pandemic scenario where migration rules are tightened as far as imaginable, that figure would not be substantially smaller.

So, like the Victorian government’s recently launched social housing stimulus, the ALP’s proposed national program would mark a promising break with the recent past, and a platform for further measures. But it would be hard to describe it as a game-changer.




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While greatly expanded social housing provision would be an essential part of any credible package to seriously address Australia’s housing affordability challenge, a far wider program of action is needed. Most importantly, such a program must also tackle our grossly unbalanced housing tax settings, boost renters’ rights and diversify the available choice of housing.

What the country needs above all is a Commonwealth commitment to assembling the national housing strategy that is so long overdue.




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The Conversation


Hal Pawson, Professor of Housing Research and Policy, and Associate Director, City Futures Research Centre, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

With diplomacy all but abandoned, Israel and the Palestinians are teetering on another war


Anthony Billingsley, UNSWThe latest violence between Israeli and Palestinian forces should come as no surprise. The issue of Palestinian statehood has been off the international agenda since US President Barack Obama effectively washed his hands of the issue. The Trump administration then focused on Israel’s relations with other Arab states at the expense of the Palestinians.

However, the tensions underlying the current violence have been building for some time and have the potential to become particularly serious.

In East Jerusalem, Israeli settlers have been trying to seize control of Palestinian homes in Sheikh Jarrah, a historic part of the city. They have resorted to the Israeli Supreme Court, which usually supports the government and settler line in matters relating to the occupied Palestinian territories. The court’s judgement was expected this week, but was deferred.

Palestinians have also been complaining about draconian restrictions imposed on worshippers during Ramadan at the Haram al-Sharif, the area including the Al-Aqsa mosque and the Dome of the Rock (which is known to Jews as the Temple Mount).

Moreover, the end of Ramadan coincided with Jerusalem Day, a celebration of Israel’s capture of East Jerusalem in the 1967 Arab-Israeli war, and with al-Nakba on May 15, the Palestinian day of mourning to mark the Arabs’ loss in the 1948 war.

These factors have given the unrest added ferocity.




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Possible war with Gaza, or civil war

Following Israel’s unilateral withdrawal from Gaza in 2005 and the 2006 Palestinian parliamentary elections, which were won by Hamas, violence between Israel and Palestinians in Gaza has been a regular occurrence.

There were major outbreaks in 2008 and 2014 when Israeli forces entered the area, resulting in the deaths of thousands of Palestinians.

There are worrying signs now that another Israeli incursion is being prepared — and another war will follow.

As the fighting has intensified, the chief prosecutor of the International Criminal Court has expressed concern war crimes are being committed. Israel has been accused of resorting to disproportionate force in Gaza, and both sides have been criticised for causing civilian deaths.

A particularly worrying aspect of these clashes is that intense fighting has also broken out between Israeli Palestinians and Jews in a number of Israeli cities and towns.

While Israeli Palestinians (who are citizens of Israel) have always been concerned about the fate of Palestinians in the Occupied Territories, they have tended to be left alone, and inter-communal violence has been largely avoided.

But harmony between the two groups is fragile, and this outbreak could have serious implications. Israel’s president is warning of a civil war.

A burning car in the Israeli city of Lod.
Clashes between Jews and Israeli Arabs have spread across the country this week.
Heidi levine/AP

Why diplomacy has failed

A major problem is there is no means of bringing about a negotiated solution to the decades-long, seemingly intractable Israeli-Palestinian conflict.

Obama attempted to initiate negotiations by appointing former Senator George Mitchell as his special envoy to the Middle East. The administration’s focus was on Israeli settlement activity in the West Bank, but it was unable to make any progress with either the Israelis or the Palestinians.

Trump’s son-in-law, Jared Kushner, developed a plan that effectively bypassed the Palestinians and focused on Israel’s relations with Arab Gulf states. This was rejected by the Palestinians.

Trump's peace plan was dismissed by the Palestinians.
Trump’s peace plan was dismissed by the Palestinians as heavily favouring Israel.
Alex Brandon/AP

The international community has been equally ineffective in trying to reduce tensions in recent weeks. Russia has called for a reconvening of the Quartet, a body formed under former US President George W. Bush’s administration that brought together the US, Russia, the United Nations and the European Union to promote an Israeli-Palestinian peace plan.

China, meanwhile, has urged the UN Security Council to take action to de-escalate tensions — a move that was blocked by Israel’s ally, the US.

The one party that might have the capacity to bring about a ceasefire and promote negotiations is the US. However, beyond issuing the usual platitudes of concern, President Joe Biden has defended Israel’s response to Palestinian rocket attacks.

Biden is focused largely on domestic issues and does not need the distraction of the Israel-Palestinian conflict, a highly divisive issue in American politics. Moreover, Hamas is listed as a terrorist organisation in the US, making it difficult for Biden to apply greater pressure on Israel.

Netanyahu, meanwhile, has done nothing to moderate tensions in recent weeks and his language on Gaza has become increasingly defiant. The conflict could be politically expedient for the beleaguered leader — it may help him regain the prime ministership after he was unable to form a government following recent elections.




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Yair Lapid, the opposition leader who was asked by the president to try to form a government last week, has had to suspend coalition negotiations while the fighting continues. His main hope is frustration with Netanyahu will encourage his negotiating partners to continue their talks to try to oust him from power.

The Palestinian side is no better placed to enter negotiations. President Mahmoud Abbas ceased engagement with Israel as a result of what he described as Israel’s refusal to negotiate and the Trump peace plan, which was widely seen as anti-Palestinian.

Abbas had called for Palestinian legislative elections in late May and presidential elections in July, but both have been postponed indefinitely. Though he hasn’t said it outright, his concern (as well as those of Israel and the US) is his party’s rival, Hamas, would easily win.

Abbas’s decision has infuriated Palestinians and added to the tensions in the East Jerusalem and Gaza over recent weeks.

Hamas militants protesting against Abbas.
Hamas militants in Gaza protesting last month against Palestinian President Mahmoud Abbas decision to postpone Palestinian elections.
Adel Hana/AP

Abbas’s hand is further weakened by the lack of support from other Arab governments, such as the UAE and Egypt. The result is Abbas is an isolated, impotent figure with few friends and waning support among the people he is supposed to represent.

Where to from here?

The relationship between Israelis and Palestinians is filled with suspicion and hate built up over decades. Both sides believe their cause is just.

While Israel’s survival is not at issue here, its future could be seriously influenced by the way its leaders handle crises like this. The departure of Netanyahu could be a positive step, but will not be decisive. The two sides need the international community to help them end the fighting and find a way out of the impasse they find themselves in.

This crisis represents an early major challenge for the Biden administration, but one the new US president will likely be reluctant to take on.




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The Conversation


Anthony Billingsley, Senior Lecturer, School of Social Sciences, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is mucormycosis, the fungal infection affecting COVID patients in India?


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Monica Slavin, Peter MacCallum Cancer Centre and Karin Thursky, The Peter Doherty Institute for Infection and ImmunityThis week we’ve seen reports of an infection called mucormycosis, often termed “black fungus”, in patients with COVID, or who are recovering from COVID, in India.

Fungal infections can be devastating. And in this case mucormycosis is adding to the burden of suffering in a country already in a deep COVID crisis.

As of March this year 41 cases of COVID-19-associated mucormycosis had been documented around the world, with 70% in India. Reports suggest the number of cases is now much higher, which is unsurprising given the current wave of COVID infections in India.

But what is mucormycosis, and how is it linked with COVID-19?

What is mucormycosis?

Mucormycosis, formerly known as zygomycosis, is the disease caused by the many fungi that belong to the fungal family “Mucorales”.

Fungi in this family are usually found in the environment (for example, in soil) and often associated with decaying organic material such as fruit and vegetables.

The member of this family which most often causes infection in humans is called Rhizopus oryzae. In India though, another family member called Apophysomyces, found in tropical and subtropical climates, is also common.

Fungus growing in a petri dish.
Mucormycosis is a disease caused by the Mucorales fungal family.
Shutterstock

In the lab, these fungi grow rapidly and have a black/brown fuzzy appearance.

The family members causing human disease grow well at body temperature and in an acidic environment (seen when tissue is dead or dying or with uncontrolled diabetes).

How do you get mucormycosis?

Mucorales are considered opportunistic fungi, meaning they usually infect people with an impaired immune system, or with damaged tissue. Use of drugs which suppress the immune system such as corticosteroids can lead to impaired immune function, as can a range of other immunocompromising conditions, like cancer or transplants. Damaged tissue can occur after trauma or surgery.

There are three ways humans can contract mucormycosis — by inhaling spores, by swallowing spores in food or medicines, or when spores contaminate wounds.

Inhalation is most common. We actually breathe in the spores of many fungi every day. But our immune system and healthy lungs generally prevent them from causing an infection.

When the lungs are damaged and the immune system is suppressed, such as is the case in patients with severe COVID, these spores can grow in our airways or sinuses and invade our bodies’ tissue.

Mucormycosis can manifest in the lungs, but the nose and sinuses are the most common site of mucormycosis infection. From there it can spread to the eyes, potentially causing blindness, or the brain, causing headache or seizures.

It can also affect the skin. Life-threatening wound infections have been seen after injuries sustained during natural disasters or on battle fields where wounds have been contaminated by soil and water.




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In the environment

We haven’t seen mucormycosis infections associated with COVID in Australia, and there have been very few in other countries. So why is the situation in India so different?

Before the pandemic, mucormycosis was already far more common in India than in any other country. It affects an estimated 14 per 100,000 people in India compared to 0.06 per 100,000 in Australia, for example.

Globally, outbreaks of mucormycosis have occurred due to contaminated products such as hospital linens, medications and packaged foods. But the widespread nature of the reports of mucormycosis in India suggests it’s not coming from a single contaminated source.

Mucorales can be found in soil, rotting food, bird and animal excretions, water and air around construction sites, and moist environments.

Although never compared, it may be that in Australia we have a lower environmental burden of Mucorales than in India.

Mucormycosis and diabetes

When diabetes is poorly controlled, blood sugar is high and the tissues relatively acidic — a good environment for Mucorales fungi to grow.

This was identified as a risk for mucormycosis in India (where diabetes is increasingly prevalent and often uncontrolled) and worldwide well before the COVID pandemic.

Of all mucormycosis cases published in scientific journals globally between 2000-2017, diabetes was seen in 40% of cases.

A recent summary of COVID-19-associated mucormycosis showed 94% of patients had diabetes, and it was poorly controlled in 67% of cases.

A man measures his blood sugar.
Diabetes is a risk factor for mucormycosis.
Shutterstock

A perfect storm

People with diabetes and obesity tend to develop more severe COVID infections. This means they’re more likely to receive corticosteroids, which are frequently used to treat COVID-19. But the corticosteroids — along with their diabetes — increase the risk of mucormycosis.

Meanwhile, COVID itself can damage airway tissue and blood vessels, which could also increase susceptibility to fungal infection.

So damage to tissue and blood vessels from COVID infection, treatment with corticosteroids, high background rates of diabetes in the population most severely affected by COVID, and, importantly, more widespread exposure to the fungus in the environment are all likely to be playing a part in the situation we’re seeing with mucormycosis in India.




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Treatment challenges

In Australia, as in many other Western countries, we’ve seen increased cases of another fungal infection, Aspergillosis, in patients who had severe COVID infections, needed intensive care management and received corticosteroids. This fungus is found in the environment but belongs to a different family.

As Aspergillosis is the most common opportunistic fungus globally, we have tests to rapidly diagnose this infection. But this is not the case with mucormycosis.

For the many patients affected with mucormyosis, the outcome is poor. About half of patients affected will die and many will sustain permanent damage.

Diagnosis and intervention as early as possible is important. This includes control of blood sugar, urgent removal of dead tissue, and antifungal drug treatment.

But unfortunately many infections will be diagnosed late and access to treatment limited. This was the case in India prior to COVID and the current demands on the health system will only make things worse.

Controlling these fungal infections will require increased awareness, better tests to diagnose them early, a focus on controlling diabetes and using corticosteroids wisely, access to timely surgery and antifungal treatment, and more research into prevention.The Conversation

Monica Slavin, Head, Department Infectious Diseases, Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre and Karin Thursky, Professor, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No vaccine ‘targets’, but Australians could still be vaccinated by end of year


Driss Ait Ouakrim, The University of Melbourne; Ameera Katar, The University of Melbourne, and Tony Blakely, The University of MelbourneThis week’s budget assumes Australians will be fully vaccinated against COVID-19 by the end of the year, despite Prime Minister Scott Morrison saying the government has no vaccination targets, modelling or forecasts.

Australians are eagerly watching the pace of the rollout, given this underpins a further budget assumption: international borders could re-open from mid-2022.

So are all Australians likely to be offered two COVID-19 doses by the end of the year?

Previous targets

In January, the government was aiming to vaccinate 80,000 people per week. It wanted 4 million Australians vaccinated by the end of March and the entire adult population vaccinated by October.

So far, we have only delivered 2.83 million doses.

The initial vaccination road map was derailed in part due to poor logistics, but more so due to lack of supply and sheer bad luck. Prioritising the AstraZeneca vaccine, with its local manufacturing capacity, seemed like a good bet but this was derailed by the rare — but real — possibility of blood clots.




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The announcement overnight of 10 million doses of Moderna mRNA vaccine this year, and 15 million next year, suggests we will see AstraZeneca quietly shuffled off stage and replaced with Moderna. However, it is unlikely to impact the current timeline.

Could we meet an end-of-year target?

In theory, yes.

Studies suggest around three-quarters of Australians are willing to have a COVID-19 vaccine. If we aim to have 75% of adults fully vaccinated with two doses this year, around 15 million Australians will need to receive 30 million doses over the next seven months.

About half of these people are 50+ or priority populations, and the other half are under 50. So that means 15 million doses before September 30 (assuming we continue using AstraZeneca), and 15 million doses from October 1, when greater stocks of the Pfizer and Moderna vaccine become available in the fourth quarter of the year.




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From now until September 30, we have 100 weekdays left to deliver 12.2 million vaccine doses, or 122,000 per day.

This is twice as many doses per day as we achieved in the past week. But it’s doable if we ramp up our vaccination capacity.

From October 1 to December 24, we have about 15 million doses to administer to vaccinate 75% of all remaining adults. This will mean 250,000 vaccinations per weekday, so doubling the daily number again in the “sprint”.

Again, this is doable if we get all our mass vaccination hubs well-oiled and efficient before then. And probably use weekends, too.

Where it gets more challenging is if many people 50 and over elect to wait for Pfizer or Moderna, meaning an even bigger “sprint”. That would require an extremely reliable supply of these two vaccines before Christmas, well-oiled delivery systems and mass vaccination sites to deliver in excess of 300,000 doses per weekday.

This implied goal of offering vaccines to all adults by the end of 2021 is ambitious, but not impossible.

So when could we open borders?

Australia will still not have COVID-19 resilience (or “herd immunity”, or something approaching it) by the end of 2021.




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If 25% of Australian adults are unvaccinated, plus 100% of children, some 40% to 45% of the population will remain unvaccinated, which is likely too low to achieve herd immunity.

Wholesale opening of our borders then is not possible – the virus would still spread with substantial disease and death.

To meet a mid-2022 target for substantially loosening border restrictions, we will need children to be vaccinated and further vaccination of adults hesitant in 2021.The Conversation

Driss Ait Ouakrim, Research Fellow, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne; Ameera Katar, Data Analyst and Research Coordinator, The University of Melbourne, and Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Israel-Palestinian violence: why East Jerusalem has become a flashpoint in a decades-old conflict


Mahmoud Illean/AP

Tristan Dunning, The University of Queensland and Martin Kear, University of SydneyWeeks of tensions between Palestinian protesters and Israeli security forces in East Jerusalem have boiled over in recent days, unleashing some of the worst violence between Israel and the Palestinians in years.

Israeli airstrikes in Gaza have left 30 Palestinians dead, including ten children, with Israeli Prime Minister Benjamin Netanyahu promising not to ease up anytime soon. Palestinians militants, meanwhile, have launched hundreds of missiles into Israel, killing three people.

Ostensibly, the rocket launches by Hamas were a response to Israeli police storming the al-Aqsa mosque compound in East Jerusalem on Laylat al-Qadr, the Night of Power, one of the holiest nights of the year for Muslims. The incident injured hundreds over the weekend.

Hamas then issued an ultimatum demanding Israeli forces withdraw from the compound — the third holiest site in Islam, part of which comprises the Wailing Wall — by a specific deadline. When Israel refused, Hamas’s military wing followed through on its threat by firing rockets toward Jerusalem, forcing Israeli lawmakers to flee parliament.

An Israeli airstrike on Gaza.
Palestinian health officials say more than 200 people have been wounded in the Israeli airstrikes on Gaza.
MOHAMMED SABER/EPA

Jerusalem divided

Beyond the mosque confrontation, though, there are broader historical and political factors at work.

Monday’s airstrikes fell on Jerusalem Day, when Israeli Jews celebrate the “reunification” of Jerusalem following the Six Day War of 1967. As the ongoing unrest demonstrates, the city is far from unified.

Adding to the tensions, thousands of Jewish ultra-nationalists had planned to march through Palestinian-dominated East Jerusalem on Jerusalem Day as a demonstration of Jewish sovereignty over the entire city.




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Israeli police changed the route at the last moment, partly due to the increasingly violent clashes between security forces and Palestinian demonstrators during Ramadan.

There were also concerns of unrest if the Israeli Supreme Court handed down its decision on whether four Palestinian families should be evicted from their homes in the Shiekh Jarrah neighbourhood of East Jerusalem, to be replaced by Jewish settlers. This is the culmination of a decades-long legal battle dismissed as “a real estate dispute” by Israeli officials.

This case is emblematic of the systematic appropriation of Palestinian homes and land in East Jerusalem since 1967. The seizure of Palestinian property is so common here, an Israeli settler was captured on video recently telling a Palestinian,

If I don’t steal your home, someone else will steal it.

The recent evictions in Shiekh Jarrah have been described by Hamas officials — and Palestinian supporters elsewhere — as a form of ethnic cleansing.

The Biden administration has also said it is “deeply concerned” about the potential evictions, while urging leaders across the spectrum to “denounce all violent acts”.

Decades of dispossession

Israeli settlement building and expansion, especially in and around East Jerusalem, is a deliberate strategy. This is not only being done to appropriate Palestinian land, but to alter the demographics of the area and prevent the establishment of a sovereign Palestine with East Jerusalem as its capital.

Israel exclusively claims Jerusalem – home of the ancient Temple Mount, the holiest site in Judaism – as its eternal undivided capital.

The dispossession of Palestinians in East Jerusalem and elsewhere in the West Bank is not new. Indeed, the expulsion of Palestinians in the areas now largely recognised as the official borders of the self-defined Jewish state of Israel was required to establish a Jewish majority.

Palestinian protest against evictions.
Palestinians sing during a protest against evictions in the Sheikh Jarrah neighbourhood.
Maya Alleruzzo/AP

On May 14, 1948, Zionist leaders unilaterally declared the independence of the state of Israel, sparking the first Arab-Israeli War. During the war, over 400 Palestinian villages and towns were depopulated and obliterated to make way for modern Jewish towns and cities.

This Saturday marks al-Nakba, or the “Catastrophe”, for Palestinians. It is the day of mourning for the loss of historical Palestine and the expulsion of over 700,000 Palestinians from their ancestral homeland.




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This process has continued throughout East Jerusalem and the West Bank since their occupation in 1967. There are now more than 5 million Palestinian refugees registered with the UN, nearly a third of whom live in refugee camps.

The plight of Palestinian refugees remains a particularly contentious issue for the two sides. A UN General Assembly resolution in 1948 asserted the right of refugees to return to the areas captured by Israel in 1948-49.

And in 1967, a UN Security Council resolution demanded Israeli forces withdraw from territories captured during the Six Day War.

International law and internal brawls

The Israeli annexation of East Jerusalem and its ongoing settler activities in the West Bank contravene international humanitarian law. They are also not recognised by the vast majority of the international community, with the notable exception of the US under the Trump administration.

Yet, Palestinian dispossession continues today with over 600,000 Israeli settlers now living across the West Bank and East Jerusalem.

The continued Israeli occupation of these territories, coupled with the appropriation of Palestinian land, are among the primary causes of conflict between the two sides.

But there are also domestic political factors at play. Hamas is a resistance organisation, which is also responsible for administering the Gaza Strip. Its legitimacy largely rests on its resistance credentials, which means the movement routinely feels obligated to demonstrate its capacity to confront perceived Israeli aggression.

This is in stark contrast to the inaction of the Hamas’ rival party, Fatah, and its leader, Palestinian President Mahmoud Abbas, who has remained largely silent in recent weeks despite the loss of Palestinian lives.




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Israel’s political system is also in crisis, with no party able to form a stable government after four inconclusive elections in the past two years (and now a fifth potentially in the offing).

With the government in flux, pro-settler parties – namely Naftali Bennett’s New Right Party – have become the kingmakers in the Knesset. Any aspiring government will likely need their backing to form a majority, which requires the support of pro-settler policies.

With all of this in mind, we can expect more violence, regardless of who eventually wins power in Israel. Unless the international community — in particular, the Biden administration — intervenes to find a meaningful solution to the conflict.The Conversation

Tristan Dunning, Sessional Lecturer, The University of Queensland and Martin Kear, Sessional Lecturer Dept Govt & Int Rel., University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is the Moderna COVID vaccine? Does it work, and is it safe?


Adam Taylor, Griffith UniversityOvernight, Boston-based pharmaceutical company Moderna announced a new supply agreement with Australia for 25 million doses of its COVID-19 vaccine.

The deal includes ten million doses against the original strain of the coronavirus to be delivered this year.

This vaccine has been widely used in countries such as Canada, United States and the United Kingdom under emergency use authorisations granted by these countries and the World Health Organization.

Moderna’s deal with Australia also includes 15 million doses of its updated variant booster vaccine candidate, estimated to be delivered in 2022.

The agreement is subject to approval by Australia’s drug regulator, the Therapeutic Goods Administration (TGA), for both the original vaccine and the booster. Moderna expects to submit an application to the TGA “shortly”.

How does Moderna’s vaccine work?

Moderna’s vaccine against the original strain is given as two doses.

Both this vaccine, and the updated booster, are mRNA vaccines (like the Pfizer vaccine). The vaccine contains genetic instructions for our cells to make the coronavirus’ “spike protein”. The mRNA is wrapped in an oily shell that protects it from being immediately degraded by the body, and ensures it’s delivered into cells after injection.

Once in the cell, the mRNA is converted into spike protein that can be recognised by the immune system. Our immune system then builds an immune response against the spike protein, and learns how to fight off the coronavirus if we encounter it in future.

Moderna’s vaccine remains stable at -20°C, the temperature of a household freezer, for up to six months. It can remain refrigerated at 4°C for up to 30 days.

As most pharmaceutical logistic companies are capable of storing and transporting products at -20°C, it’s relatively easy to store and distribute this vaccine. By contrast, Pfizer’s mRNA COVID-19 vaccine needs to be stored long-term below -60°C, though unopened vials can be stored at freezer temperatures for up to two weeks.




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Is it safe and effective?

Phase 3 clinical trials of the vaccine, with over 30,000 participants, showed 94.1% efficacy at preventing COVID-19 as well as complete protection against severe forms of the disease.

Researchers did not identify safety concerns, with the most common side effects being transient pain at the injection site, and headache or tiredness that typically lasted for up to three days.

These clinical trials, however, largely occurred prior to the emergence of SARS-CoV-2 variants of concern. These include B.1.1.7, which emerged from the United Kingdom, and B.1.351, first detected in South Africa.




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Can it protect against variants?

Subsequent studies have investigated the potential for these variants to escape the protection offered by Moderna’s vaccine. Preliminary studies have identified slight, although not significant, reductions in the protection it offers against the B.1.351 variant, originating in South Africa.

In response to this data, Moderna updated its mRNA vaccine formulation to account for the changes in the spike protein present in the B.1.351 variant. In March this year, it started phase 1 and 2 clinical trials to investigate the safety and ability of its variant vaccine to provoke an immune response.

Preliminary, preclinical studies suggest vaccination with the variant vaccine was effective at increasing neutralising antibodies against the B.1.351 variant.

Preclinical studies also suggest a vaccine containing an equal mix of its original vaccine, and the B.1.351 vaccine, was most effective at providing broad cross-variant protection, including against the P.1 variant that originated in Brazil.

In people already fully vaccinated against the original strain, clinical studies demonstrated a booster dose of Moderna’s variant vaccine achieved a higher number of neutralising antibodies against the B.1.351 variant, than simply giving a booster dose of Moderna’s original strain vaccine.

Moderna’s vaccines can be rapidly reformulated to target emerging variants. This is largely thanks to the splendour of the mRNA technology, simply requiring the genetic sequence of the virus.

It’s possible Moderna will be able to update its vaccine to cover future variants of the coronavirus so we can quickly provide people with protection to emerging strains.




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Moderna revealed it’s in discussions with the federal government about manufacturing its vaccines onshore in Australia. This follows news that both Victoria and New South Wales have committed money towards developing mRNA vaccine manufacturing capability.

This is a move that would not only further secure Australia’s supply of COVID-19 vaccines, but kick start the development of an industry within Australia that has the potential to impact multiple diseases.The Conversation

Adam Taylor, Early Career Research Leader, Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How can the world help India — and where does that help need to go?


Channi Anand/Ap/AAP

Dileep Mavalankar, Public Health Foundation of IndiaIndia is in the grip of an unprecedented second wave of COVID-19.

Official data suggests new cases have crossed 400,000 per day, and the daily death count is around 4,200. But the actual numbers may be significantly higher.

We know the hospital system is stretched beyond its limits and there are dire shortages in the country’s expanded vaccine drive.

Clearly, India is in need of help from beyond its borders. What can other countries do?

Help already pledged

In this moment of crisis, the international community has already stepped in to provide some help.




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Several countries including the United States, United Kingdom, United Arab Emirates, Russia, Germany, and France have already sent aid such as oxygen and related equipment, ventilators, medicines and ICU equipment. The US has also said it will provide vaccine help, and critical drugs.

Australia has announced it will send ventilators, surgical masks and other personal protective equipment.

How should this help be used?

This aid is all critical. But given the size of India’s population — almost 1.4 billion — more will be needed and even this will not be enough.

Given this, we need to make best use of the incoming aid. India needs to conduct a quick national and state-level needs assessment exercise. Where is help most needed? And where can it be most useful?

Indians in Prayagraj line up for a COVID vaccine.
India’s vaccine program has begun but has been hit by shortages.
Rajesh Kumar Singh/AP/AAP

This should include an assessment of capacities for care and utilisation by each major city and rural area. For instance, there’s a need to evaluate diagnostic and testing capacities and their distribution across the country. An important measure missing at this point is high capacity testing systems which can help increase testing.

The review would also help answer: what are the strengths of the private and NGO sectors and how can they be harnessed? Where exactly are the most vulnerable, and how best can we reach them? Such a review would also help in ensuring that sophisticated machines such as ventilators are not sent to places where they cannot be operated or maintained.

At the same time, there’s a need to look for available internal funds and services that can strengthen India’s efforts.

The importance of vaccines

Given the emerging shortage of vaccines, they will, of course, be the most helpful gift in the long run. Many countries have booked more than they need. Such excess vaccine doses can be offered to India, as it will need millions of doses of imported vaccine to cover its population rapidly.

Besides the very visible gaps in emergency and critical care — such as oxygen and ventilators — technical expertise in epidemiology, biostatistics, data sciences and modelling as well as diagnostic technology would be very useful.




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We need help in conducting expert analysis of the situation, prediction modelling by each state and city, and assistance on how to improve systems to record and analyse the huge amount of data that is streaming in.

Sharing knowledge and collaboration in areas such as understanding mutations via gene sequencing, identification of variants of concern, and studying their virulence and transmissibility will also help.

Such efforts are intangible and would fall in the realm of “knowledge aid”, and hence, governments may not be keen to prioritise this. But foreign support could also come in the form of specific funds and grants.

Help must come with no strings attached

In this process, the countries offering the support should not put any conditions or delay the process. Immediate assistance is needed as the peak of the current wave seems to be only a few weeks away.

This support should reach where the most vulnerable get COVID services: public hospitals, healthcare centres run by non-government organisations, and community COVID care centers. The technical help in epidemiology and data sciences should be given to state health departments and major research centres located in cities.

Most importantly, foreign support should strengthen the health system and not be a burden on it.

Only if we are in it together, can we all hope to defeat the virus.The Conversation

Dileep Mavalankar, Vice President western region, Public Health Foundation of India

This article is republished from The Conversation under a Creative Commons license. Read the original article.